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Thromboembolic and bleeding events in ICU patients with COVID-19: A nationwide, observational study

Lene Russell1, Sarah Weihe2, Emilie Kabel Madsen3

  • 1Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Acta Anaesthesiologica Scandinavica
|October 20, 2022
PubMed

Insights

COVID-19 patients in intensive care units (ICUs) frequently experienced thromboembolic and bleeding events. Increased doses of thromboprophylaxis did not appear beneficial for these critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Hematology

Background:

  • Coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs) face a heightened risk of thromboembolic complications.
  • Understanding the incidence and predictors of these events is crucial for managing critically ill patients.

Purpose of the Study:

  • To describe the occurrence of thromboembolic and bleeding events in Danish ICU patients with COVID-19 during the initial pandemic waves.
  • To identify factors associated with these events and their impact on 90-day mortality.

Main Methods:

  • A sub-study of the Danish Intensive Care Covid database included all SARS-CoV-2 patients admitted to ICUs between March 2020 and June 2021.
  • Coagulation variables, thromboembolic/bleeding events, and heparin use were registered. Cox regression analyses assessed associations with mortality.

Main Results:

  • Of 1369 patients, 12% experienced thromboembolic events and 23% had bleeding events (6% major bleeding).
  • Mechanical ventilation and elevated D-dimer predicted thrombosis; low platelets and hematological malignancy predicted bleeding.
  • While 76% received increased thromboprophylaxis, thromboembolic events were not linked to mortality, but bleeding events were (HR 1.55).

Conclusions:

  • Thromboembolic and bleeding complications are common in critically ill COVID-19 patients.
  • The data suggest that increased doses of thromboprophylaxis may not confer significant benefits in this population.
Abstract

Keywords:
COVID-19bleedingthromboprophylaxisthrombosis

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